Diffuse Alveolar Hemorrhage

Abstract

Diffuse alveolar hemorrhage (DAH) refers to a clinical syndrome resulting from injury to the alveolar capillaries, arterioles, and venules leading to red blood cell accumulation in the distal air spaces. It is defined by the clinical triad of hemoptysis, anemia, and progressive hypoxemia. Chest radiographs reveal non-specific patchy or diffuse, bilateral pulmonary infiltrates.The diagnosis requires confirmation of the alveolar hemorrhage by bronchoscopy in which serial bronchoalveolar lavage samples reveal persistently hemorrhagic fluid. A number of conditions are associated with DAH, and underlying disease determines the prognosis and the treatment regimen. While there is no uniformly accepted classification of DAH, it is generally categorized according to the underlying histology. EtiologyA number of conditions have been associated with the clinical syndrome of DAH (table 1). In one study of biopsyconfirmed DAH, Wegener's granulomatosis (WG) was the most frequent underlying condition, followed by Goodpasture's syndrome, idiopathic pulmonary hemosiderosis, and collagen vascular diseases. Overall, vasculitis (either WG or microscopic polyangiitis [MAP]) was the most frequent, representing 41% of cases [1].

Diffuse Alveolar Haemorrhage Complicated by Pulmonary Embolism—Problems with Treatment

“…Usually, it is defined by the clinical triad of haemoptysis, anaemia and hypoxaemia, but the final diagnosis requires confirmation by bronchoscopy in which serial bronchoalveolar lavage samples reveal persistent haemorrhagic fluid [1]. The most common causes of DAH are antineutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV) and anti-GBM disease [4].…”

“…Diffuse alveolar haemorrhage (DAH) is a potentially life-threatening manifestation requiring aggressive treatment [1]. Most commonly, it occurrs in the course of systemic vasculitis.…”

Lane-Hamilton syndrome: case report and review of the literature

“…1c). The diagnosis of secondary IPH relies on exclusion of other disorders in which diffuse alveolar opacities is the cardinal sign [10,20]. Several studies focus on lung biopsies and electron microscopy, but fail to clarify the exact pathogenic mechanism of the syndrome [9,10,14,20].…”

“…The condition occurs either in the absence of other disorders associated with intrapulmonary haemorrhage or with extra-pulmonary disease, the so-called diffuse alveolar haemorrhage [20]. According to this definition, pulmonary haemosiderosis may be primary or secondary ( Table 1).…”

“…According to this definition, pulmonary haemosiderosis may be primary or secondary ( Table 1). The secondary form of pulmonary haemosiderosis usually occurs in association with cardiac or different vasculitis-associated auto-immune diseases [10,20]. Classically, IPH is characterised by the triad of iron deficiency anaemia, pulmonary infiltrates and haemoptysis without an obvious cause.…”